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Functional bowel problems
Functional bowel disorders are probably the most common conditions that a gastroenterologist will encounter. Outpatient clinics are frequented by patients with symptoms of dyspepsia, abdominal discomfort, bloating, nausea/vomiting, diarrhoea and constipation. These symptoms are often vague and the cause difficult to determine; in some ways it can be a relief to recognise an abnormality, such as an ulcer or inflammation, that can be treated successfully! However, what happens if there is no abnormality on examination and all the conventional tests, such as blood tests or an endoscopy, are normal? How should one treat these patients? Are the symptoms all in the mind? These patients are often very vulnerable, having already seen a number of gastroenterologists and not received adequate answers. This sadly leads to overinvestigation and often reinvestigation of the patient. The lack of a diagnosis leads to patient dissatisfaction with the medical profession, but also frustration on the part of the clinician. Unfortunately, this is mainly because of the paucity of efficacious treatments for, as yet, an undefined diagnosis and patients are labelled as having ‘ functional’ problems.